Ricci Claudio, Taffurelli Giovanni, Campana Davide, Ambrosini Valentina, Pacilio Carlo Alberto, Pagano Nico, Santini Donatella, Brighi Nicole, Minni Francesco, Casadei Riccardo
Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy.
Department of Haematology and Oncology (DIMES), Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Italy.
Pancreatology. 2017 May-Jun;17(3):471-477. doi: 10.1016/j.pan.2017.03.004. Epub 2017 Mar 15.
There is currently there is substantial controversy regarding the best management of non-functioning pancreatic neuroendocrine tumours ≤2 cm.
Retrospective study involving 102 surgically treated patients affected by non-functioning pancreatic neuroendocrine tumours. Patients having small tumours (≤2 cm) (Group A) and those having large tumours (>2 cm) (Group B) were compared regarding demographics, clinical and pathological factors with the aim of evaluating the risk of malignancy and survival times.
The small tumours were T3-4 in 11% and G2-3 in 36.6% of cases; lymph node and distant metastases were present in 31% and 8% of the cases, respectively. When small and large tumours were compared, significant differences were found in relation to the presence of symptoms (P = 0.012), tumour status (P > 0.001), grading (P > 0.001) and years lost due to disability (P = 0.002). Multivariate analysis of the factors predicting malignancy and survival times showed that tumour size was related only to grading (P < 0.001). The years of life lost and disability adjusted life years were influenced by age at of diagnosis, the presence of symptoms and years lost due to disability only by grading.
Tumour size alone did not seem to be reliable in predicting malignancy because, first, small tumours (≤2 cm) could present lymph node or distant metastases, and could be G2-3 in a non-negligible percentage of cases and second, their risk of malignancy and survival time are similar to large tumours. Additional parameters have to be considered in order to establish the proper management of small tumours, such as age at diagnosis, presence of symptoms and grading.
目前，对于直径≤2 cm的无功能性胰腺神经内分泌肿瘤的最佳治疗方法存在很大争议。
对102例接受手术治疗的无功能性胰腺神经内分泌肿瘤患者进行回顾性研究。比较小肿瘤（≤2 cm）患者（A组）和大肿瘤（>2 cm）患者（B组）的人口统计学、临床和病理因素，以评估恶性风险和生存时间。
小肿瘤患者中，11%为T3-4期，36.6%为G2-3级；淋巴结转移和远处转移分别见于31%和8%的病例。比较小肿瘤和大肿瘤时，发现症状出现情况（P = 0.012）、肿瘤分期（P > 0.001）、分级（P > 0.001）和因残疾导致的失能年数（P = 0.002）存在显著差异。对预测恶性风险和生存时间的因素进行多变量分析表明，肿瘤大小仅与分级有关（P < 0.001）。失能调整生命年数受诊断时年龄、症状出现情况和因残疾导致的失能年数影响，仅分级对其有影响。
仅肿瘤大小似乎不能可靠地预测恶性风险，原因如下：其一，小肿瘤（≤2 cm）可能出现淋巴结转移或远处转移，且在相当比例的病例中可能为G2-3级；其二，其恶性风险和生存时间与大肿瘤相似。为了确定小肿瘤的适当治疗方法，必须考虑其他参数，如诊断时年龄、症状出现情况和分级。
